WHO OECD Pharm System

HOW
PHARMACEUTICAL
SYSTEMS
ARE ORGANIZED
IN ASIA AND THE PACIFIC
HOW
PHARMACEUTICAL
SYSTEMS
ARE ORGANIZED
IN ASIA AND THE PACIFIC
© World Health Organization/Organisation for Economic Co-operation and Development 2018
ISBN 978 92 9061 848 5
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Cataloguing-in-Publication (CIP) data. 1. Asia. 2. Pharmaceutical preparations – economics, supply and distribution.
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CONTENTS
Executive summary ..................................................................... 1

Introduction ............................................................................... 2
Socio-economics ........................................................................ 3
Human resources ....................................................................... 3
Health expenditure ..................................................................... 4
Pharmaceutical expenditure ......................................................... 4
Pharmaceutical regulation and pricing ........................................... 6
Pharmaceutical procurement and reimbursement ............................. 6
Country profiles ......................................................................... 7
EXECUTIVE SUMMARY
There are important differences in the markets for medicines in countries in Asia and the Pacific
in this study. These are mainly due to the political, financial and regulatory environments as well
as characteristics of the pharmaceutical manufacturing industry. However, all countries face
the test of transition brought about by demographic changes, shifting epidemiological trends
and increasing inequities, among others. As with other regions of the world, a characteristic of
lower- and upper-middle-income countries is that pharmaceuticals account for a high proportion
of health expenditures. Medicines account for a larger share of the health budgets in resource-
constrained countries.
Pharmaceutical systems are complex and involve several intermediaries between medicines
manufacturers and consumers. This suggests the need for better coordination among various
agencies and relevant stakeholders involved. The intricate pharmaceutical landscape demands
a better understanding of how pharmaceutical markets are organized, regulated and financed to
foster policies aimed at achieving universal and equitable access to essential medicines.
Achieving equitable access to affordable, safe, efficacious and quality medicines through sound
pharmaceutical policies, programmes and other interventions has remained a continuing
challenge at all levels of health system strengthening for countries, with some performing better
than others. This reality is even more pronounced in countries that are currently working towards
universal health coverage where a large part of pharmaceutical spending is still out of pocket.
HOW PHARMACEUTICAL SYSTEMS ARE ORGANIZED IN ASIA AND THE PACIFIC 1

INTRODUCTION
Medicines, together with other health technologies, are one of the building
blocks of a health system. Without them, it is impossible to achieve
desirable health outcomes for individual patients and communities.
As countries make further progress towards universal health coverage, essential
medicines, more than ever, are crucial to achieving health and inclusive socioeconomic
development. Sustainable Development Goal target 3.8 mentions the importance of
“access to safe, effective, quality and affordable essential medicines and vaccines for all”
as a central component of universal health coverage.
Access to essential medicines encompasses quality, safety and efficacy of drugs,

as well as their availability, affordability and appropriate use. However, improving
access to quality-assured essential medicines is not an end in itself. It is a means to
improving health status, promoting well-being and achieving equity across populations.
Demographic, epidemiological and economic transitions continue to generate major
challenges for essential medicines.
Addressing issues around access to medicines requires a comprehensive understanding

of how pharmaceutical systems are organized and function. This report presents profiles
of 14 countries in Asia and the Pacific – Australia, Brunei Darussalam, Cambodia,
China, Indonesia, Republic of Korea, Lao People’s Democratic Republic, Malaysia,
Mongolia, New Zealand, Philippines, Singapore, Thailand and Viet Nam – that outline
resources, structures and processes relating to ensuring availability and accessibility of
pharmaceuticals in specific country settings and their interactions with the health-care
system. The report represents an outcome of the activities of the Asia Pacific Network
on Access to Medicines under Universal Health Coverage, a joint initiative by the WHO
Regional Office for the Western Pacific, the Organisation for Economic Co-operation and
Development (OECD) and the OECD Korea Policy Centre, with the support of the WHO
Collaborating Centre for Health Systems and Financing at Seoul National University.
2 HOW PHARMACEUTICAL SYSTEMS ARE ORGANIZED IN ASIA AND THE PACIFIC

SOCIO-ECONOMICS
Countries featured in this report range from Brunei Darussalam with a population of less than
half a million to China with 1.36 billion inhabitants. The median life expectancy at birth across
countries in this study is 75 years. The Lao People’s Democratic Republic (64 years), Mongolia (68
years) and the Philippines (69 years) show a life expectancy at birth lower than that of the world
population (71.4 years) and much lower than that of OECD countries (80.6 years). Differences
in life expectancy across countries may be attributed to differences in income levels, living
standards, lifestyles, education and accessibility of quality health services.
Across countries, the highest proportions of children aged below 15 years were observed in the
Philippines (32.0%) and Cambodia (31.0%), whereas the lowest proportions were reported in
the Republic of Korea (15.0%), Singapore (16.0%) and China (16.6%). The highest proportion of
people aged over 60 years (20.0%) was recorded in Australia and New Zealand. Of note is that the
proportion of people aged over 60 years is expected to increase significantly in the coming years,
which can lead to an increased burden on those of working age to sustain spending for a range of
services, including health, for an ageing population.
In terms of gross domestic product (GDP) per capita, the countries featured in this report include
high-income countries – Singapore ($ 82 208.90 per capita), Brunei Darussalam ($ 67 131.80),
Australia ($ 46 244.10), New Zealand ($ 37 340.00) and the Republic of Korea ($ 34 321.60);
upper-middle income countries – Malaysia ($ 24 951.10), Thailand ($ 15 346.70) and China ($ 13
166.70); and lower-middle income countries – Mongolia ($ 11 945.70), Indonesia ($ 10 517.00), the
Philippines ($ 6982.40), Viet Nam ($ 5525.80), the Lao People’s Democratic Republic ($ 5278.20)
and Cambodia ($ 3228.40). While GDP is a direct measure of economic production, it is also an
indirect measure of economic well-being of a country.
HUMAN RESOURCES
Australia has the highest number of physicians per 10 000 population (35.2), followed by the
Lao People’s Democratic Republic (29), Mongolia (28.4) and New Zealand (28.4). The Republic
of Korea (14.6 per capita) has the highest number of doctor consultations per capita per year,
followed by Australia (7.6 per capita), Mongolia (6.1 per capita) and China (5.4 per capita). Across
OECD countries, on average 34 doctors per 10 000 population are reported. They guarantee
6.9 consultations per capita per year. The number of pharmacists per 1000 population is
consistently low, from lower-middle-income (Cambodia, 0.14) to high-income countries (Brunei
Darussalam, 0.17).
The Republic of Korea (10.3 per 1000 population) has the highest number of hospital beds,
while Cambodia (0.7 per 1000 population) and Indonesia (0.6 per 1000 population) reported the
lowest numbers. On average, OECD countries report 4.7 beds per 1000 population. The health
system capacity and utilization of health-care services are correlated with available providers of
services. Lower utilization of health-care services may suggest scarcity of resources, including
human resources.

HEALTH EXPENDITURE
Total health expenditure (THE) per capita shows a significant variation across the countries in the
study, with the highest level reported in Australia ($ 4357.00) and the lowest in the Lao People’s
Democratic Republic ($ 35.50). THE as a share of GDP is highest in high-income countries such
as Australia (10.0%), New Zealand (9.4%) and the Republic of Korea (7.4%), with the exception
of Singapore (4.3%) and Brunei Darussalam (1.8%). For comparison, OECD countries spend on
average 9% of GDP on health.
The share of government in total health spending varies from as high as 93.8% in Brunei
Darussalam to as low as 18.9% in China, whereas out-of-pocket spending accounts for more than
half of the THE in Cambodia (74.2%), the Philippines (53.7%) and the Lao People’s Democratic
Republic (52.6%). Out-of-pocket spending accounts for a much greater share of health
expenditures in lower-middle-income countries than in high-income countries. Some countries
have social health insurance systems which constitute a significant portion of THE, such as the
Republic of Korea (42.9%), China (37.7%) and Viet Nam (24.07%).
PHARMACEUTICAL EXPENDITURE
A large variation in pharmaceutical spending is observed across countries in the study. Per
capita pharmaceutical spending ranges from $ 27.3 in the Lao People’s Democratic Republic and
$ 683.5 in Australia (Figure 1).
800
Figure 1
684
Pharmaceutical expenditure per capita,
700
international dollars (US$ Purchasing
600
600
583
Power Parity), 2014
500
USD PPP
400 392
370
300 288
199
200
147
124
109 104
100 81
27
0
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* data provided by the country

Source: WHO Global Health Observatory 2016, OECD Health Statistics

Pharmaceutical spending as a share of THE ranges from 9.7% in New Zealand to 44% in Cambodia
(Figure 2). Lower- and upper-middle-income countries have a higher total pharmaceutical
expenditure (TPE) as a share of THE when compared to high-income countries. Across OECD
countries, pharmaceutical spending represents on average 16% of total health spending.
50 Figure 2
45 44
Pharmaceutical expenditure as a share of
total expenditure on health per capita, 2014
40 39
35 34
35
% of total health expenditure on health per capita
33 33
30
26
25 23
21 20
20 19
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The contribution of public and private sources to financing TPE varies greatly across countries as
well. Countries that have a significantly higher public sector share are either high-income (Brunei
Darussalam, New Zealand, Republic of Korea and Australia) or upper-middle income countries
(Thailand and Malaysia). Countries that have a significantly higher private sector share are lower-
middle-income countries, such as Indonesia (85.7%), the Philippines (85.0%), Viet Nam (83.5%),
the Lao People’s Democratic Republic (83.5%), Cambodia (77.5%) and Mongolia (74.0%) (Figure 3).
100
Figure 3
91 90
90 Government share of pharmaceuticals
80 expenditure, 2010–2014
70 68
% of total expenditure on pharmaceuticals
60 58
54 54
50
42
40
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PHARMACEUTICAL REGULATION AND PRICING
All countries have existing regulatory authority for pharmaceuticals as well as key legislations.
Except for Singapore, all have a formal National Medicines Policy. In terms of pricing, not all
countries have a dedicated agency that sets or controls the price of pharmaceutical products,
such as in Brunei Darussalam, Cambodia, Mongolia and Singapore. In these countries, pricing
of pharmaceuticals in the public sector is not regulated. The pricing of pharmaceuticals in the
private sector is regulated only in Indonesia, the Philippines and Viet Nam.
Internal price referencing is not used in Indonesia, the Republic of Korea, Mongolia and
Singapore. External price referencing is not used in Indonesia, Mongolia, New Zealand and
Singapore. Except for Australia, Brunei Darussalam and Singapore, there is value-added tax on
medicines in countries in the study ranging from 5% in Viet Nam to 17% in China.
PHARMACEUTICAL PROCUREMENT AND REIMBURSEMENT

All countries have a dedicated agency that selects pharmaceuticals for procurement and
reimbursement, while only Brunei Darussalam, Cambodia and Indonesia do not have an
organization that is tasked to conduct health technology assessment. Countries have varying
numbers of products in their Essential Medicines List, Procurement List and Reimbursement List.

COUNTRY PROFILES
Pharmaceutical System AUSTRALIA
SOCIOECONOMICS 1,5 24 127 200 83 years

Population Life Expectancy
20%
Percentage
of Adults
19%
Percentage
of Children
46 244.1
GDP / Capita (PPP)
Aged over Aged below
at Birth 60 Years 15 Years
HUMAN
35.2
per 10 000
0.9
per 1000
3.8
per 1000
7.6
per capita
RESOURCES 2,3,5 population population population
No. of Physicians No. of Pharmacists Hospital Beds Doctor Consultations
8.4%
10% Private
Prepaid Plans
33% 5.8%
67% 67%
4357.3
Private Other Private
HEALTH Public
General
Government
EXPENDITURE 4,5 18.8%
Total Health Expenditure / Out-of-Pocket
Capita (PPP)
Total Health Expenditure Public vs Private Share of Composition of
as a Share of GDP Total Health Expenditure Total Health Expenditure
PHARMACEUTICAL
EXPENDITURE 3
683.5
Total Pharmaceutical
15.7%
Pharmaceutical Expenditure
53.5%
Public
46.5%
Private
as a Share of Total Health Public vs Private Share of

Expenditure / Capita (PPP) Expenditure / Capita Total Pharmaceutical Expenditure
Regulatory Authority for Pharmaceuticals Pharmaceutical Legislation National Medicines Policy

PHARMACEUTICAL
REGULATION Therapeutic Goods National Health Act Non-legislative
Administration 1953 National Medicines Policy 2000
Agency that Sets Price Pricing Regulation Pricing Regulation

in the Public Sector
YES in the Private Sector
YESa
Department of Health
PRICING
Free Price External Price Internal Price VAT on
Pricing? Negotiations? Referencing? Referencing? Medicines
NO YES YES YES NO
Body Responsible for Selection

of Products for Public Pharmaceutical Benefits Body Responsible for Health Pharmaceutical Benefits
Procurement/Reimbursement Advisory Committee Technology Assessment Advisory Committee
PROCUREMENT /
REIMBURSEMENT
19 786
No. of Registered
No data available
No. of Products on
No data available
No. of Products on
5200
No. of Products on
Medicines Essential Medicines List Procurement List Reimbursement List
a For medicines included in the Pharmaceutical Benefits Scheme

Pharmaceutical System Flowchart
NEW MEDICINE
National Regulatory Authority THERAPEUTIC GOODS ADMINISTRATION, DEPARTMENT OF HEALTH
MARKET TASKS Pre-market assessment, post-marketing monitoring and enforcement of standards, licensing of local
AUTHORIZATION / manufacturers and verifying overseas manufacturers’ compliance
LICENSING
CRITERIA Quality, safety and efficacy/performance
REGULATIONS Therapeutic Goods Act 1989, Therapeutic Goods Regulation, Non-legislative National Medicines Policy 2000
PHARMACEUTICAL BENEFITS ADVISORY COMMITTEE
SELECTION PURPOSE Recommendation of medicines for inclusion in the Pharmaceutical Benefits Scheme (PBS)
CRITERIA Comparative safety, clinical efficacy and cost-effectiveness
PROCUREMENT Community pharmacies and hospitals
Pharmaceutical Benefits Scheme, in accordance with the National Health Act 1953
For PBS-reimbursable pharmaceuticals For non-PBS-reimbursable pharmaceuticals
PRICING AND
REIMBURSEMENT TASKS Negotiation of final price at which a drug Include over-the-counter drugs (with some exemptions),
should be listed on the PBS (approved lifestyle drugs and hospital drugs supplied to inpatients
ex-manufacturer price; agreed fixed mark-up (using state and territory funding)
for wholesalers; agreed administration,
handling and infrastructure fee/ mark-up, and There are no price controls for manufacturers, wholesale
dispensing fee and dangerous drug fee if distributors, hospitals and pharmacies.
applicable, for hospitals and pharmacies)
SYSTEM Patients contribute to the costs of medicines

under the PBS through co-payments.
Wholesale and retail distributions are done privately.

DISTRIBUTION
Methods of supply from the pharmacy include imprest, individual inpatient supply, prescriptions, requisitions and borrowing.
CLIENTS
REFERENCES WPR/2017/DHS/002
1 World health statistics (2015) [online database]. Geneva: World Health Organization (http://www.who.int/gho/publications/world_health_statistics/2015/en/, accessed
25 November 2016). ©World Health Organization 2017
2 Pharmacy Board of Australia (2015). Statistics [website]. Australia (http://www.pharmacyboard.gov.au/About/Statistics.aspx, accessed 15 November 2016).
3 Health at a glance: Asia/ Pacific (2016). Paris: The Organisation for Economic Co-operation and Development and World Health Organization Some rights reserved. This work is available
(http://www.oecd.org/health/health-at-a-glance-asia-pacific-23054964.htm, accessed 2 December 2016). under the CC BY-NC-SA 3.0 IGO licence.
4 Global health expenditure database (2016) [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database, accessed 25 November 2016).
5 Data provided by country
Pharmaceutical System BRUNEI DARUSSALAM
SOCIOECONOMICS 3 417 000

Population
77 years
Life Expectancy
7%
Percentage
of Adults
24%
Percentage
of Children
67 131.8
GDP / Capita (PPP)
HUMAN
17.7
per 10 000
0.17
per 1000
2.7
per 1000
3.9
per capita
RESOURCES 1,2,3 population population population
No. of Physicians No. of Pharmacistsa Hospital Beds Doctor Consultations
6.1% 0.07%
1.8% Private Private
Prepaid Plans
0.07%
HEALTH
EXPENDITURE 3
1777.8
Total Health Expenditure /
93.9%
Public
93.84%
General
Other Private
6%
Government Out-of-Pocket
Capita (PPP)
PHARMACEUTICAL
EXPENDITURE 2
369.9
20.8%
89.6%
Public
10.4%
Private


PHARMACEUTICAL
REGULATION Brunei Darussalam Medicines
Medicines Order 2007, Medicines (Licensing,
Standard Provision and Fees) Regulations 2010, National Medicines Policy 2014
Control Authority Medicines (Labelling) Regulations 2010, Poisons Act
1956 and Misuse of Drug Regulations

NO in the Private Sector
NO
None
PRICING
YES YES YES YES NO

of Products for Public Drug Advisory Committee, Body Responsible for Health
Technology Assessment No data available
Procurement/Reimbursement Ministry of Health
PROCUREMENT /
REIMBURSEMENT
2145
No. of Registered
1038
No. of Products on
1311
No. of Products on
No data available
No. of Products on
a Pharmaceutical personnel
NEW MEDICINE
National Regulatory Authority BRUNEI DARUSSALAM MEDICINES CONTROL AUTHORITY, MINISTRY OF HEALTH
MARKET TASKS Issuance of licenses of pharmaceutical establishments and registration certificates of medicinal products
AUTHORIZATION /
LICENSING CRITERIA Quality, safety and efficacy
REGULATIONS Poisons Act 1956, Medicines Order 2007, Medicines (Licensing, Standard Provision and Fees) Regulations 2010
and Medicines (Labelling) Regulations 2010, National Medicines Policy 2014
DRUG ADVISORY COMMITTEE, MINISTRY OF HEALTH
SELECTION PURPOSE Regular updating of the National Standard Drug List and approval of Named Patient Basis Prescriptions
CRITERIA Appropriateness to disease patterns in the country
Ministry of Health (in compliance with financial regulations and procurement guidelines by State Tender Board,
PROCUREMENT Ministry of Finance)
There is no price control for medicines.
For the public sector For the private sector
PRICING AND
REIMBURSEMENT
There is free health care for all, including medicines for Private insurance is available.
inpatients and outpatients.
Payment is out of pocket.
Through the country’s four government hospitals, 16

health centres and 64 primary care facilities From manufacturer to wholesale distributor to
DISTRIBUTION dispensing unit
Travelling health clinics and flying medical services for
remote areas
CLIENTS
2 Health at a glance: Asia/ Pacific (2016). Paris: The Organisation for Economic Co-operation and Development and World Health Organization
(http://www.oecd.org/health/health-at-a-glance-asia-pacific-23054964.htm, accessed 2 December 2016). Some rights reserved. This work is available
3 Data provided by country under the CC BY-NC-SA 3.0 IGO licence.
Pharmaceutical System CAMBODIA
SOCIOECONOMICS 1 15 135 000 73 years

8%
Percentage
of Adults
31%
Percentage
of Children
3228.4
GDP / Capita (PPP)
HUMAN
1.7
per 10 000
0.14
per 1000
0.7
per 1000
0.7
per capita
RESOURCES 1,2 population population population
5.7%
22% 22%
Public General
183.2
Government
HEALTH 74.2%
EXPENDITURE 3 78% 3.8% Out-of-Pocket
Total Health Expenditure / Private Other Private
Capita (PPP)
PHARMACEUTICAL
EXPENDITURE 2
80.7
44%
22.5%
Public
77.5%
Private


PHARMACEUTICAL
REGULATION Department of Drugs and Food, Law on the Management National Medicines Policy 2010
Ministry of Health of Pharmaceuticals 2007

NO
None
PRICING
YES YES YES YES 10%

of Products for Public Body Responsible for Health
Ministry of Health Technology Assessment None
Procurement/Reimbursement
PROCUREMENT /
REIMBURSEMENT
16 920
No. of Registered
770
No. of Products on
No data available
No. of Products on
No data available
No. of Products on
NEW MEDICINE
National Regulatory Authority DEPARTMENT OF DRUGS AND FOOD, MINISTRY OF HEALTH
MARKET TASKS Licensing and registration of drugs and medical devices, assurance of quality and control of pharmaceuticals
AUTHORIZATION /
REGULATIONS Law on the Management of Pharmaceuticals 2007, National Medicines Policy 2010
NATIONAL COMMITTEE FOR THE ESSENTIAL MEDICINES LIST
SELECTION PURPOSE Revision of the Essential Medicines List every two years
Ministry of Health (for some products through international development partners)

PROCUREMENT and private sector pharmacies
There is no price control for medicines.
PRICING AND
REIMBURSEMENT
There are nominal user charges, but exemptions are Private insurance is available.
given to the poor.
Health Equity Funds cover majority of the population.
Essential drugs are provided to public health facilities on From manufacturer to wholesale distributor to
DISTRIBUTION a quarterly basis through the Ministry of Health - Central dispensing unit
Medical Store according to the Essential Medicines List.
CLIENTS
3 Global health expenditure database (2016) [online database]. Geneva: World Health Organization (http://apps.who.int/nha/database, accessed 25 November 2016). under the CC BY-NC-SA 3.0 IGO licence.
Pharmaceutical System CHINA
SOCIOECONOMICS 1,2 1 360 720 000 75 years

14.8%
Percentage
of Adults
16.6%
Percentage
of Children
13 166.7
GDP / Capita (PPP)
HUMAN
17.3
per 10 000
0.3
per 1000
4.55
per 1000
5.4
per capita
18.9%
5.5% General
Government
37.7%
44.2% Social Health
730.5 7.7%
Insurance
HEALTH 55.8% Private
32% Other Private
EXPENDITURE 2 Public Out-of-Pocket
Total Health Expenditure / 4.5%
Private
Capita (PPP) Prepaid Plans

PHARMACEUTICAL
EXPENDITURE 2
288.1
39.4%
42.2%
Public
57.8%
Private


PHARMACEUTICAL
REGULATION National Essential Medicines Policy
China Food and Drug Administration Drug Administration Law 2001
2009
Pricing Bureau, under the National

NO
Development and Reform Commission
PRICING
YES YES YES YES 17%
Ministry of Human Resources

Bodies Responsible for Selection and Social Security
of Products for Public and
Body Responsible for Health China National Health
Procurement/Reimbursement National Health and Family Planning Technology Assessment Development Research Center
Commission
PROCUREMENT /
REIMBURSEMENT
168 000
No. of Registered
520
No. of Products on
Varies by Province
No. of Products on
2535
No. of Products on
NEW MEDICINE
National Regulatory Authority CHINA FOOD AND DRUG ADMINISTRATION
TASKS Registration and market authorization of pharmaceutical products, publication of drug standards and
MARKET classification system, and supervision of implementation of regulatory standards at the local level
AUTHORIZATION /
REGULATIONS Drug Administration Law 2001, Regulations for Implementation of the Drug Administration Law, Provisions for
Drug Registration
NATIONAL ESSENTIAL MEDICINES LIST
SELECTION PURPOSE Listing of drugs under zero-profit policy and setting of requirements for revenues from such products
PROCUREMENT National Health and Family Planning Commission, private hospitals and retail pharmacies
The National Development and Reform Commission governs the prices of pharmaceutical products.
Based on regulations (e.g. Price Law), market-driven pricing exists.
All essential medicines are included in the insurance reimbursement lists.

PRICING AND
REIMBURSEMENT
The Ministry of Human Resources and Social Security and
the National Health and Family Planning Commission
decide on reimbursements according to related
regulations Payment is out of pocket.
(e.g. Social Insurance Law).
Drugs listed as Category A under the National

Reimbursement Drug List are fully reimbursed. Category
B drugs are reimbursed at 70–80%.
The Ministry of Commerce decides on the administration

of pharmaceutical distribution based on related
regulations.
From manufacturer to wholesale distributor
DISTRIBUTION to dispensing unit
Involves a three-tier health service delivery system,
including primary health facilities, secondary hospitals
and tertiary hospitals
CLIENTS
1 China Health and Family Planning Statistical Yearbook (2014). China: Peking Union Medical College Press.
2 Health at a glance: Asia/ Pacific (2016). Paris: The Organisation for Economic Co-operation and Development and World Health Organization ©World Health Organization 2017
(http://www.oecd.org/health/health-at-a-glance-asia-pacific-23054964.htm, accessed 2 December 2016).
Some rights reserved. This work is available
under the CC BY-NC-SA 3.0 IGO licence.
Pharmaceutical System INDONESIA

8%
Percentage
of Adults
29%
Percentage
of Children
10 517
GDP / Capita (PPP)
HUMAN
3.2
per 10 000
No data 0.6
per 1000
No data
RESOURCES 2 population population
1.7%
2.8% Private
Prepaid Plans
37.8% 33.6%
General 11.8%
299.4
Public Government Other Private
HEALTH 62.2%
EXPENDITURE 2 Private 45.3% 7.8%
Total Health Expenditure / Out-of-Pocket Social Health
Capita (PPP) Insurance

PHARMACEUTICAL
EXPENDITURE 2
103.9
34.7%
14.3%
Public
85.7%
Private


PHARMACEUTICAL
REGULATION National Agency for Regulation 1010/2008, Health Act of National Medicines Policy 2006
Drug and Food Control Republic of Indonesia No. 36/2009

YES
Ministry of Health
PRICING
YES YES NO NO 10%
Body Responsible for Selection National Committee on

of Products for Public Body Responsible for Health
Selection and Use of Essential Technology Assessment None
Procurement/Reimbursement Medicines
PROCUREMENT /
REIMBURSEMENT
18 000
No. of Registered
No data available
No. of Products on
720
No. of Products on
923
No. of Products on
NEW MEDICINE
National Regulatory Authority NATIONAL AGENCY FOR DRUG AND FOOD CONTROL (NA-DFC)
TASKS Assessment, organization, implementation and monitoring of national policy in food and drug evaluation field;
MARKET registration, marketing authorization and licensing
AUTHORIZATION /
CRITERIA Quality, safety, efficacy, risk and people’s needs
LICENSING
REGULATIONS NA-DFC decree number HK.00.05.3.1950 (Criteria and Procedure of Drug Registration),National Medicines Policy
2006, No. 1010/MENKES/PER/XI/2008 (Regulation 1010/2008), National Health Policy (Health Act of Republic of
Indonesia No. 36/2009)
NATIONAL COMMITTEE ON SELECTION AND USE OF ESSENTIAL MEDICINES, MINISTRY OF HEALTH
SELECTION PURPOSE Selection of medicines and development of the National Medicines Formulary
PROCUREMENT Ministry of Health, local governments and private sector pharmacies
The Ministry of Health sets both the ceiling prices for tender of generic medicines for public sector procurement, and the
maximum retail price in the private sector.
PRICING AND Primary health-care facilities are reimbursed based on

capitation payment, with medicines costed at prices
REIMBURSEMENT listed on the E-catalogue.
For public hospitals contracted under BPJS Kesehatan,
there is fixed fee per patient visit (including 7-day For private hospitals contracted under BPJS Kesehatan,
medicines supply) based on diagnostic groups, as well as there is fixed fee per patient visit (including 7-day
fee-for-service price for other medicines. medicines supply) based on diagnostic groups, as well as
fee-for-service price for other medicines.
District governments establish retribution fee for patients
based on their capacity to subsidize health services.
Through a Central Medical Store at national level with From manufacturer to wholesale distributor to dispensing
DISTRIBUTION 530 public warehouses in the secondary tier of public unit and with many players at each level
distribution
CLIENTS
Pharmaceutical System REPUBLIC OF KOREA

17%
Percentage
of Adults
15%
Percentage
of Children
34 321.6
GDP / Capita (PPP)
HUMAN
22.4
per 10 000
1.28
per 1000
10.3
per 1000
14.6
per capita
RESOURCES 2 population population population
7.4% 4%
36.1% Other Private
54.1% 45.9%
Out-of-Pocket
5.8%
HEALTH
EXPENDITURE 2
2530.6
Public Private 42.9%
Social Health
Private
Prepaid Plans
11.2%
Insurance
Capita (PPP) General Government

PHARMACEUTICAL
EXPENDITURE 2
583.4
23.1%
58.4%
Public
41.6%
Private


PHARMACEUTICAL
REGULATION
Ministry of Food and Drug Safety Pharmaceutical Affairs Act National Medicine Policy Plan

NO
Ministry of Health and Welfare
PRICING
NO YES YES NO 10%
Body Responsible for Selection National Evidence-based

of Products for Public Health Insurance and Review Body Responsible for Health
Technology Assessment Healthcare Collaborating
Procurement/Reimbursement and Assessment Service
Agency
PROCUREMENT /
REIMBURSEMENT
39 847
No. of Registered
No data available
No. of Products on
No data available
No. of Products on
17 798
No. of Products on
NEW MEDICINE
National Regulatory Authority PHARMACEUTICAL SAFETY BUREAU, MINISTRY OF FOOD AND DRUG SAFETY
MARKET
AUTHORIZATION / TASKS Drug approval and registration
LICENSING
CRITERIA Quality, safety, efficacy and information on production and sale in origin country (for imported products)
REGULATIONS Pharmaceutical Affairs Act
HEALTH INSURANCE REVIEW AND ASSESSMENT SERVICE AND PHARMACEUTICAL BENEFIT REVIEW COMMITTEE
SELECTION PURPOSE Decision on which medicines are to be included and not in the Positive List for reimbursement by the National
Health Insurance Service, reviewed by the National Health Insurance Policy Deliberation Committee (NHIPDC)
CRITERIA Clinical and cost effectiveness, and budget impact
PROCUREMENT Public and private hospitals, clinics and pharmacies employing medical tenders and competitive bids
Medicine prices are regulated if such costs are reimbursed by the National Health Insurance Service.
For pharmaceuticals in the Positive List For pharmaceuticals not in the Positive List
Reimbursement ceilings for new products are determined

through negotiations between the National Health Insurance
PRICING AND Service and the manufacturer, reviewed by the NHIPDC and
REIMBURSEMENT announced by the Minister of Health and Welfare.
Pharmaceutical Benefit Review Committee sets listed price for

essential drugs if price negotiation fails. The prices are reviewed Payment is out of pocket.
by NHIPDC and announced by the Minister of Health and Welfare.
Reimbursement ceiling price for generic products and off-patent

drugs is 53.55% of the innovator product's price, pursuant to
the regulations of the Ministry of Health and Welfare.
Zero margin policy is applied in order for the reimbursement to

be based on actual transaction price.
DISTRIBUTION All public and private hospitals, clinics and pharmacies are legally obliged to subscribe as providers.
CLIENTS
Pharmaceutical System LAO PEOPLE'S DEMOCRATIC REPUBLIC
SOCIOECONOMICS 1,3 6 492 228

Population
64 years
Life Expectancy
6.5%
Percentage
of Adults
32%
Percentage
of Children
5278.2
GDP / Capita (PPP)
HUMAN
29
per 10 000
0.19
per 1000
1.5
per 1000
No data
2.7% 3.3%
Social Health
38.2% Insurance
and Private
42.4% 57.6%
98.5
General Prepaid Plans
Government
HEALTH Public Private 52.6%
EXPENDITURE 3 Out-of-Pocket 5.9%
Total Health Expenditure / Other Private
Capita (PPP)
PHARMACEUTICAL
EXPENDITURE 3
27.3
20.3%
16.5%
Public
83.5%
Private


PHARMACEUTICAL
REGULATION Food and Drug Department, Law on Drugs and Medical Products 2011, National Medicines Policy 2003
Ministry of Health Regulation Governing Drug Registration 2003

NO
Ministry of Health (for public sector)
PRICING
YES YES YES YES 10%
Body Responsible for Selection Public Hospital Pharmacy

of Products for Public Body Responsible for Health Medical Product
Division, Food and Drug Technology Assessment Supply Center
Procurement/Reimbursement Department, Ministry of Health
PROCUREMENT /
REIMBURSEMENT
1521
No. of Registered
374
No. of Products on
746
No. of Products on
374
No. of Products on
NEW MEDICINE
National Regulatory Authority FOOD AND DRUG DEPARTMENT, MINISTRY OF HEALTH
MARKET TASKS Medicines evaluation and registration

AUTHORIZATION /
REGULATIONS Law on Drugs and Medical Products 2011, Regulation on Drug Registration 2003, National Medicines Policy 2003
PUBLIC HOSPITAL PHARMACY DIVISION, FOOD AND DRUG DEPARTMENT, MINISTRY OF HEALTH
SELECTION PURPOSE Listing of medicines in the Essential Medicines List and subsequent review every 2 to 3 years
CRITERIA Quality, safety, efficacy, therapeutic advantage and cost
Different methods of procurement are used in the public sector, such as collective negotiation procurement, centralized
PROCUREMENT procurement and decentralized procurement.
There are no price controls for manufacturers, importers and wholesale distributors.
PRICING AND As of 2015, 21% of the population is covered by health

insurance schemes. This number is expected to rise with
REIMBURSEMENT the launch of a new tax-based system. There is no regulation on margins or mark-ups.
Selling price of medicines is determined by the retail
price with maximum of 25% mark-up in accordance with
the guidelines of the drug revolving funds.
Medicines are free for all insurance members and other

vulnerable groups (e.g. mothers, children under 5,
and the poor).
Through seven central-level hospitals (of which three are

DISTRIBUTION specialized centres), four regional hospitals, 16 provincial Through 222 private clinics and 1993 private pharmacies
hospitals, 130 district hospitals and 894 health centres
CLIENTS
Pharmaceutical System MALAYSIA

9%
Percentage
of Adults
26%
Percentage
of Children
24 951.1
GDP / Capita (PPP)
HUMAN
12.6
per 10 000
0.34
per 1000
1.9
per 1000
3.5
per capita
7.1%
4.2% Private
Prepaid Plans
55.2% 44.8% 2.4%

HEALTH
EXPENDITURE 2
1040.2
Public Private
54.6% 35.3%
General
Government
Out-of-Pocket
Other Private
0.6%
Social Health
Capita (PPP) Insurance

PHARMACEUTICAL
EXPENDITURE 2
198.8
19.1%
54.3%
Public
45.7%
Private


PHARMACEUTICAL
REGULATION National Pharmaceutical Poisons Act 1952, Sale of Drugs Act 1952,
Control of Drugs and Cosmetics National Medicines Policy 2012
Regulatory Agency
Regulations 1984
Ministry of Domestic Trade,

NO
Cooperatives and Consumerismb
PRICING
YES YES YES YES 6%c
Body Responsible for Selection Pharmaceutical Services

of Products for Public Pharmaceutical Services Body Responsible for Health
Technology Assessment Division/Medical Development
Procurement/Reimbursement Division, Ministry of Health
Division, Ministry of Health
PROCUREMENT /
REIMBURSEMENT
10 680
No. of Registered
4300
No. of Products on
1695 d
No. of Products on
1695
No. of Products on
b Monitoring function only
c Zero for prescription drugs and items listed on the National Essential Medicines List
d Number of international nonproprietary names of medicines listed
NEW MEDICINE
National Regulatory Authority NATIONAL PHARMACEUTICAL REGULATORY AGENCY, MINISTRY OF HEALTH
MARKET TASKS Authorization and categorization of drugs in the market

AUTHORIZATION /
REGULATIONS Poisons Act 1952, Sale of Drugs Act 1952 and Control of Drugs and Cosmetics Regulations 1984
PHARMACEUTICAL SERVICES DIVISION, MINISTRY OF HEALTH
SELECTION PURPOSE Listing of medicines in the Ministry of Health Formulary for use in the public sector
CRITERIA Clinical advantage (comparative efficacy/effectiveness and safety), best and current treatment options, population needs,
current treatment guidelines and economic criteria (cost of treatment, overall budget and pharmacoeconomic impact)
Ministry of Health and public health facilities use any of the following methods: through appointed concession company, by
PROCUREMENT central tender for purchases above a set limit, or by local purchasing for purchases below a set limit according to the
procedures and instruction of Ministry of Finance.
There are no price controls.
Pricing is managed in the public sector through tenders depending on annual turnover value for all. Further price negotiation is
carried out for single-source medicines.

PRICING AND
REIMBURSEMENT
Pricing is managed through the procurement procedures Private insurance is available.
and instruction of Ministry of Finance.
DISTRIBUTION Through 366 hospitals and 11 212 clinics, both public and private
CLIENTS
Pharmaceutical System MONGOLIA

Population
68 years
Life Expectancy
6%
Percentage
of Adults
27%
Percentage
of Children
11 945.7
GDP / Capita (PPP)
HUMAN
28.4
per 10 000
0.6
per 1000
7
per 1000
6.1
per capita
2.7%
Other Private
4.7%
38.5% 0.3%
Private
55.4% 44.6% General
565.1
Prepaid Plans
Government
HEALTH Public Private
EXPENDITURE 2 41.6% 16.9%
Out-of-Pocket Social Health
Total Health Expenditure / Insurance
Capita (PPP)
PHARMACEUTICAL
EXPENDITURE 2
147.2
26%
26%
Public
74%
Private


PHARMACEUTICAL
REGULATION Ministry of Health, Center for Health Law on Medicines and
Development and General Agency for National Medicines Policy 2014
State Inspection Medical Devices 2010

NO
None
PRICING
YES NO NO NO 10%

of Products for Public National Health Body Responsible for Health Technical Evaluation
Procurement/Reimbursement Insurance Council Technology Assessment Committee, Ministry of Health
PROCUREMENT /
REIMBURSEMENT
4688
No. of Registered
486
No. of Products on
No data available
No. of Products on
190
No. of Products on
NEW MEDICINE
National Regulatory Authority MEDICINES AND MEDICAL DEVICES UNIT, CENTER FOR HEALTH DEVELOPMENT,
HUMAN DRUG COUNCIL, MINISTRY OF HEALTH
MARKET
AUTHORIZATION / TASKS Medicines and diagnostics evaluation and registration
LICENSING
CRITERIA Quality, safety and efficacy
REGULATIONS Law on Medicines and Medical Devices 2010, National Medicines Policy 2014
ESSENTIAL MEDICINES LIST
SELECTION PURPOSE National registration of medicines, guidance for public sector procurement and insurance/reimbursement schemes
Public hospitals purchase medicines and diagnostics from private companies through competitive tender as guided by
PROCUREMENT Law of Procurement 2000. Local health departments conduct tender through the procurement division of aimag and
city government offices.
PRICING AND
REIMBURSEMENT There are margins in the distribution chain: central There is no regulation on margins or mark-ups.
medical stores, 10%; regional store, 15%; and public
medicine outlet, 10%. Payment is out of pocket.
Discounted rate of medicines in the reimbursement list is
50–70% of the approved price. Insurer pays the rest.
Through 16 specialized hospitals, four regional diagnostic

and treatment centres, 17 aimag general hospitals,
12 district general hospitals, six rural general hospitals
DISTRIBUTION and 546 primary health care facilities that include family Through 1184 private hospitals and clinics
health centres, soum health centres, inter-soum hospitals
and village hospitals
CLIENTS
Pharmaceutical System NEW ZEALAND

Population
82 years
Life Expectancy
20%
Percentage
of Adults
20%
Percentage
of Children
37 340
GDP / Capita (PPP)
HUMAN
28.4
per 10 000
0.77
per 1000
2.8
per 1000
3.7
per capita
4.32%
9.4% 17.7%
Private Prepaid Plans
Private
2.29%
Other Private
HEALTH
EXPENDITURE 2,3
4018.3 82.3% 75.24%
General
11.04%
Out-of-Pocket
Total Health Expenditure / Public Government 7.11%
Capita (PPP) Social Health Insurance

PHARMACEUTICAL
EXPENDITURE 2
391.6
9.7%
68.1%
Public
31.9%
Private


PHARMACEUTICAL
REGULATION Medicines and Medical Devices The Medicines Act 1981, Medicines New Zealand 2007
Safety Authority The Medicines Regulations 1984
Pharmaceutical Management Agency

NO
PRICING
NO YES NO YES 15%

GST

of Products for Public Pharmaceutical Body Responsible for Health
Technology Assessment Ministry of Health
Procurement/Reimbursement Management Agency
PROCUREMENT /
REIMBURSEMENT
6262
No. of Registered
more than 4500
No. of Products on
a
more than 4500
No. of Products on
more than 4500
No. of Products on
a Products on the Pharmaceutical Schedule

NEW MEDICINE
National Regulatory Authority MEDICINES AND MEDICAL DEVICES SAFETY AUTHORITY
MARKET
AUTHORIZATION / TASKS Regulation of therapeutic products
LICENSING
CRITERIA Factors for consideration relating to need, health benefits, costs and savings, and suitability
REGULATIONS The Medicines Act 1981, The Medicines Regulations 1984
PHARMACEUTICAL MANAGEMENT AGENCY
SELECTION PURPOSE Securing best health outcomes from pharmaceutical treatments within a fixed budget
CRITERIA Factors for consideration relating to need, health benefits, costs and savings, and suitability
Pharmaceutical Management Agency as the single purchaser of pharmaceuticals on a willing buyer - willing seller basis using
strategies such as negotiation, tendering, request for proposals, rebates and reference pricing
PROCUREMENT
An annual tender process is employed when medicines come off patent with the winning supplier getting the sole supply of the
public health care market for a fixed term of usually three years.
There are no price controls.
For the publicly funded pharmaceuticals For the non-publicly funded pharmaceuticals
PRICING AND
REIMBURSEMENT Eligible patients pay a co-payment (from $0 to $15), and
in some instances additional costs (e.g. when the price is Payment is out of pocket.
higher than the subsidy, fees for after-hours dispensing
and special packaging).
Pharmaceuticals are mostly distributed by private wholesalers who deliver to public hospitals and to privately owned
DISTRIBUTION community pharmacies for dispensing to patients.
CLIENTS
3 The World Bank (2016). Databank [website]. (http://databank.worldbank.org/data/home.aspx, accessed 25 November 2016). under the CC BY-NC-SA 3.0 IGO licence.
4 Data provided by country
Pharmaceutical System PHILIPPINES

8%
Percentage
of Adults
32%
Percentage
of Children
6982.4
GDP / Capita (PPP)
No data
HUMAN
3.56
per 10 000
4.19
per 1000
1.2
per 1000
available
20.3%
General Government
4.7% 14%
34.3% Social Health
Insurance
328.9
Public
HEALTH 65.7% 53.7% 3.4%
Other Private
EXPENDITURE 2 Private Out-of-Pocket
Capita (PPP) Private
Prepaid Plans
PHARMACEUTICAL
EXPENDITURE 2
109.4
33.3%
15%
Public
85%
Private


PHARMACEUTICAL
REGULATION Food and Drug Administration,
Generics Act 1988, Consumer Act of the Philippines 1992,
Universally Accessible Cheaper and Quality Medicines Act
Dangerous Drugs Board 2008, Food and Drug Administration Act 2009, Expanded Philippine Medicines Policy
Senior Citizens Act 2011, Philippine Pharmacy Act 2016

YESa
PRICING
NO YES YES YES 12%

of Products for Public Formulary Executive Council, Body Responsible for Health
Technology Assessment Department of Health
Procurement/Reimbursement Department of Health
PROCUREMENT /
REIMBURSEMENT
19 381
No. of Registered
676
No. of Products on
676
No. of Products on
676
No. of Products on
a Only for selected medicines through Maximum Drug Retail Price

NEW MEDICINE
National Regulatory Authority FOOD AND DRUG ADMINISTRATION
TASKS Licensing, market authorization, regulation and classification of drugs

MARKET
AUTHORIZATION / CRITERIA Quality, safety and efficacy
LICENSING
REGULATIONS Generics Act 1988, Consumer Act of the Philippines 1992, Universally Accessible Cheaper and Quality Medicines
Act 2008, Food and Drug Administration Act 2009, Expanded Senior Citizens Act 2011, Philippine Pharmacy Act
2016, Philippine Medicines Policy
FORMULARY EXECUTIVE COUNCIL, PHARMACEUTICAL DIVISION, DEPARTMENT OF HEALTH
SELECTION PURPOSE Evaluation of application for inclusion to the Philippine National Formulary
CRITERIA Local public health context, burden of disease, comparative efficacy and safety relative to the current standard of care
or medicines listed in the Philippine National Formulary, comparative cost-effectiveness, affordability and equity
Department of Health and local governments using the 2016 Revised Implementing Rules and Regulations of Republic Act No.
9184, otherwise known as the Government Procurement Reform Act
PROCUREMENT
Private sector hospitals and pharmacies
The Government can enforce Maximum Drug Retail Price following set criteria and processes in the Universally Accessible
Cheaper and Quality Medicines Act 2008.
The Drug Price Reference Index sets reference prices for procurement in public health facilities and for drug reimbursements
through social health insurance.
PRICING AND For the public sector For the private sector
REIMBURSEMENT
Access to basic essential drugs in public primary health
care facilities through mixed provision from national and
local governments Payment is out of pocket or
through health maintenance organizations.
Under the social health insurance scheme, case rate
policy for total inpatient care includes essential drugs.
Currently, there is no outpatient drug benefit.
Mixed public-private system
DISTRIBUTION Public health services are provided through a network of hospitals, local health units and village health stations.
Private sector supplies health services through hospitals, clinics, diagnostic centres and pharmacies.
CLIENTS
1 Philippine Statistics Authority (2015). (http://psa.gov.ph, Accessed 15 November 2016).
3 Department of Health – Health Human Resources Development Bureau (2014). (http://www.doh.gov.ph/node/655, Accessed 15 November 2016). Some rights reserved. This work is available
Pharmaceutical System SINGAPORE
SOCIOECONOMICS 1,2,3 5 470 000

Population
83 years
Life Expectancy
17%
Percentage
of Adults
16%
Percentage
of Children
80 191.5
GDP / Capita (PPP)
HUMAN
21
per 10 000
0.5
per 1000
2.2
per 1000
1.7
per capita
4.3% 15.1%
Voluntary
54.2% 45.8% 43.8% Health Care
2538
Paymenta
General
HEALTH Public Private
EXPENDITURE 2,3
Government
30.7% 10.4%
Total Health Expenditure / Out-of-Pocket Social
Health Careb
Capita (PPP)
as a share of GDP Total Health Expenditure Total Health Expenditure
PHARMACEUTICAL No data available No data available No data available

EXPENDITURE Pharmaceutical Expenditure
Total Pharmaceutical as a Share of Total Health Public vs Private Share of

PHARMACEUTICAL
REGULATION
Health Sciences Authority Health Products Act No Formal National Medicines Policy

NO
None
PRICING
YES YES NO NO NO

of Products for Public Drug Advisory Committee, Body Responsible for Health Agency for
Procurement/Reimbursement Ministry of Health Technology Assessment Care Effectiveness
PROCUREMENT /
REIMBURSEMENT
5500
No. of Registered
No data available
No. of Products on
590
No. of Products on
1040
No. of Products on
a Health-care expenditures paid out from voluntary or private sources

b Combined compulsory medical savings accounts, social health insurance, and other government-supported schemes not classified elsewhere
NEW MEDICINE
National Regulatory Authority HEALTH SCIENCES AUTHORITY
MARKET
AUTHORIZATION / TASKS Licensing and market authorization of drugs
REGULATIONS Health Products Act
DRUG ADVISORY COMMITTEE, MINISTRY OF HEALTH
SELECTION PURPOSE Recommendation for inclusion of drugs to the Standard Drug List
CRITERIA Clinical relevance and cost-effectiveness in the management of common diseases afflicting the majority
The Group Procurement Office consolidates drug purchases for the health-care system at the national level.
PROCUREMENT
Private sector hospitals and pharmacies
PRICING AND
REIMBURSEMENT All people are entitled to subsidized medical services
and treatments at government polyclinics and hospitals. Payment is out of pocket.
The Drug Advisory Committee decides on suitability of
drugs for subsidy based on disease burden, clinical need,
comparative clinical benefits and safety,
cost-effectiveness and budget impact.
The primary care sector consists of around 1900 private medical clinics and 17 government polyclinics.
DISTRIBUTION Hospital care in the public sector is organized into two vertically integrated delivery networks, National Healthcare Group and
Singapore Health Services.
The Community Health Assist Scheme subsidizes visits to any of the 720 participating medical clinics and 460 dental clinics for
acute conditions, specified chronic illnesses, specified dental procedures, and recommended health screening.
CLIENTS
2 The World Bank (2016). Databank [website]. (http://databank.worldbank.org/data/home.aspx, accessed 25 November 2016).
3 Data provided by country Some rights reserved. This work is available
Pharmaceutical System THAILAND

14%
Percentage
of Adults
18%
Percentage
of Children
15 346.7
GDP / Capita (PPP)
HUMAN
4.9
per 10 000
0.19
per 1000
2.3
per 1000
2.1
per capita
4.6% 23% 10.8%

Other Private
Private
69.1%
HEALTH
EXPENDITURE 3
658.2 77%
Public
General
Government
12.2%
Out-of-Pocket

Capita (PPP) Social Health Insurance

PHARMACEUTICAL
EXPENDITURE 2,3
599.84
33.6%
90.6%
Public
9.4%
Private


PHARMACEUTICAL
REGULATION
Food and Drug Administration Drug Act 1967 National Drug Policy 1981

NO
National Essential Drugs List Subcommittee
PRICING
YES YES YES YES 7%
Body Responsible for Selection Health Intervention and

of Products for Public National Essential Drugs List Body Responsible for Health
Technology Assessment Technology Assessment
Procurement/Reimbursement Subcommittee
Program
PROCUREMENT /
REIMBURSEMENT a a
22 667
No. of Registered
766
No. of Products on
106 b
No. of Products on
766
No. of Products on
a Number of international nonproprietary names of medicines listed

b Number of international nonproprietary names of medicines on Central Procurement List for Universal Coverage Scheme and Social Security Scheme
NEW MEDICINE
National Regulatory Authority FOOD AND DRUG ADMINISTRATION, MINISTRY OF PUBLIC HEALTH
TASKS Licensing, registration, inspection, surveillance and adverse event monitoring for all drugs and drug companies
MARKET CRITERIA Safety, quality, efficacy, stability studies and process validation (for new drugs); product information, product
AUTHORIZATION / manufacturing, quality control, bioequivalence studies and literature supporting safety and efficacy claims (for
LICENSING generic drugs)
REGULATIONS Drug Act 1967, National Drug Policy 1981
NATIONAL ESSENTIAL DRUGS LIST SUBCOMMITTEE
SELECTION PURPOSE Setting up of the National Essential Drugs List and drug use criteria
CRITERIA National health need, safety, efficacy, compliance, quality, total treatment cost, cost-effectiveness, equity,
availability, national affordability and budget impact
Public hospitals can purchase medicines, either essential or non-essential, using the budget that they can be reimbursed with from health
insurances through capitation.
PROCUREMENT For some high-volume items, regional/provincial procurement is done to get the lowest prices.
There are around 106 items considered as special access items for which the National Health Security Office and Social Security Office
contract the Government Pharmaceutical Organization to do central procurement and delivery to health-care providers.
National Essential Drugs List Subcommittee sets up prices especially for high-cost drugs.
Drugs are purchased in the public sector at the price capped by the Median Price System. The Ministry of Public Health conducts
centralized bargaining for medicines with no or limited market competition and collects prices of other products from regional bidding
conducted by public hospitals to set the reference purchasing prices for public hospitals.
For individuals and drugs covered by For individuals and drugs not covered by
any public insurance system any public insurance system
PRICING AND
REIMBURSEMENT Drugs in the National Essential Drugs List can be reimbursed
with or without any co-payment under the drug benefit
packages of the tax-based insurance systems.
Drugs outside the National Essential Drugs List can be Private insurance is available
reimbursed under fee-for-service outpatient system of the
Civil Service Medical Benefit Scheme. Payment is out of pocket.
Health facilities determine whether they need to use drugs
outside the List since drugs are included in the capitation
budget of insurance systems.
Private insurance is available to supplement coverage.
The public health facilities are at various levels: regional, provincial, district, subdistrict and village.
DISTRIBUTION
There are 322 private hospitals, 18 503 medical clinics, 16 692 drugstores and 2058 traditional medicine drugstores.
CLIENTS
1 The World Bank (2016). Databank [website]. (http://databank.worldbank.org/data/home.aspx, accessed 25 November 2016).
3 Data provided by country Some rights reserved. This work is available
Pharmaceutical System VIET NAM

10%
Percentage
of Adults
23%
Percentage
of Children
5525.8
GDP / Capita (PPP)
HUMAN
11.9
per 10 000
No data
available 2.5
per 1000
2.3
per capita
RESOURCES 1,2 population population
7.1% 9.19%
29.98% Other
Private
General
54.1% 45.9%
390.5
Government
HEALTH Public Private 24.07%
EXPENDITURE 2 38.76% Social Health
Insurance
Total Health Expenditure / Out-of-Pocket
Capita (PPP)
PHARMACEUTICAL
EXPENDITURE 2
123.7
33.2%
16.5%
Public
83.5%
Private


PHARMACEUTICAL
REGULATION National Strategy for Pharmaceutical
Drug Administration of Vietnam The Pharmacy Law (No. 105/2016/QH13)
Sector Development
Ministry of Health, together with

YES
Ministry of Financea
PRICING
YES YES YES YES 5%

of Products for Public Department of Health Body Responsible for Health Health Strategy and
Procurement/Reimbursement Insurance, Ministry of Health Technology Assessment Policy Institute
PROCUREMENT /
REIMBURSEMENT
45 000
No. of Registered
466
No. of Products on
100 b
No. of Products on
900 c
No. of Products on
a Price control function only

b For centralized procurement only
c Active pharmacological ingredients
NEW MEDICINE
National Regulatory Authority DRUG ADMINISTRATION OF VIETNAM, MINISTRY OF HEALTH
MARKET TASKS Licensing, registration, inspection, advertising management, price management of chemical and herbal
AUTHORIZATION / medicines and pharmaceutical companies
LICENSING
CRITERIA Quality, safety and efficacy
REGULATIONS The Pharmacy Law (No. 105/2016/QH13), National Strategy for Pharmaceutical Sector Development
DEPARTMENT OF HEALTH INSURANCE, MINISTRY OF HEALTH
SELECTION PURPOSE Development of the Major Drug List as basis for selecting drugs and as reference for insurance reimbursement
Centralized procurement for national programs as guided by the Bidding Law (No. 43/2013/QH13), The Pharmacy Law (No.
PROCUREMENT 105/2016/QH13) and Pricing Law
Decentralized procurement for hospitals and provincial health departments
Free pricing based on market economy is in place.
For some publicly procured medicines, declaration of wholesale price is required.
PRICING AND
REIMBURSEMENT Vietnam Social Security guides Provincial (and District) Drugs on the Reimbursement Drug List are funded
Social Securities for payment and managing cost of drugs through the Health Insurance Fund through private health
as they directly pay health-care providers. establishments (hospitals) under contract with a health
insurance institution.
Drugs on the Reimbursement Drug List are funded
through the Health Insurance Fund through government Outside the Reimbursement Drug List and the contracted
health establishments (hospitals) under contract with a establishments, payment is out of pocket.
health insurance institution.
DISTRIBUTION Public health facilities include 1030 hospitals, 641 clinics, 62 rehabilitation and sanatorium hospitals, 10 757 medical service
units in wards and communes, and 715 medical offices in companies.
There are more than 4000 drugstores, 30 000 private clinics, and about 140 private hospitals.
CLIENTS

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ISBN 978 92 9061 848 5

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Printed in the Philippines

Executive summary ..................................................................... 1

HOW PHARMACEUTICAL SYSTEMS ARE ORGANIZED IN ASIA AND THE PACIFIC 1

Access to essential medicines encompasses quality, safety and efficacy of drugs,

Addressing issues around access to medicines requires a comprehensive understanding

2 HOW PHARMACEUTICAL SYSTEMS ARE ORGANIZED IN ASIA AND THE PACIFIC

HOW PHARMACEUTICAL SYSTEMS ARE ORGANIZED IN ASIA AND THE PACIFIC 3

* data provided by the country

4 HOW PHARMACEUTICAL SYSTEMS ARE ORGANIZED IN ASIA AND THE PACIFIC

* data provided by the country

Source: WHO Global Health Observatory 2016, OECD Health Statistics

HOW PHARMACEUTICAL SYSTEMS ARE ORGANIZED IN ASIA AND THE PACIFIC 5

PHARMACEUTICAL PROCUREMENT AND REIMBURSEMENT

6 HOW PHARMACEUTICAL SYSTEMS ARE ORGANIZED IN ASIA AND THE PACIFIC

SOCIOECONOMICS 1,5 24 127 200 83 years

as a Share of Total Health Public vs Private Share of

Regulatory Authority for Pharmaceuticals Pharmaceutical Legislation National Medicines Policy

Agency that Sets Price Pricing Regulation Pricing Regulation

NO YES YES YES NO

Body Responsible for Selection

a For medicines included in the Pharmaceutical Benefits Scheme

National Regulatory Authority THERAPEUTIC GOODS ADMINISTRATION, DEPARTMENT OF HEALTH

PHARMACEUTICAL BENEFITS ADVISORY COMMITTEE

CRITERIA Comparative safety, clinical efficacy and cost-effectiveness

PROCUREMENT Community pharmacies and hospitals

For PBS-reimbursable pharmaceuticals For non-PBS-reimbursable pharmaceuticals

SYSTEM Patients contribute to the costs of medicines

Wholesale and retail distributions are done privately.

SOCIOECONOMICS 3 417 000

as a Share of Total Health Public vs Private Share of

Regulatory Authority for Pharmaceuticals Pharmaceutical Legislation National Medicines Policy

Agency that Sets Price Pricing Regulation Pricing Regulation

YES YES YES YES NO

Body Responsible for Selection

DRUG ADVISORY COMMITTEE, MINISTRY OF HEALTH

CRITERIA Appropriateness to disease patterns in the country

There is no price control for medicines.

For the public sector For the private sector

Through the country’s four government hospitals, 16

SOCIOECONOMICS 1 15 135 000 73 years

as a Share of Total Health Public vs Private Share of

Regulatory Authority for Pharmaceuticals Pharmaceutical Legislation National Medicines Policy

Agency that Sets Price Pricing Regulation Pricing Regulation

YES YES YES YES 10%

Body Responsible for Selection

National Regulatory Authority DEPARTMENT OF DRUGS AND FOOD, MINISTRY OF HEALTH

NATIONAL COMMITTEE FOR THE ESSENTIAL MEDICINES LIST

CRITERIA Appropriateness to disease patterns in the country

Ministry of Health (for some products through international development partners)

There is no price control for medicines.

For the public sector For the private sector

SOCIOECONOMICS 1,2 1 360 720 000 75 years

Total Health Expenditure Public vs Private Share of Composition of

as a Share of Total Health Public vs Private Share of

Regulatory Authority for Pharmaceuticals Pharmaceutical Legislation National Medicines Policy

Agency that Sets Price Pricing Regulation Pricing Regulation

Pricing Bureau, under the National